Tag: SSPE

Why Do We Only Worry About Measles?

Anti-vaccine folks often claim that health officials only worry about measles and measles outbreaks.

They can’t understand why anyone gets concerned by a few measles cases here and there, not understanding that a lot of work goes into containing measles outbreaks and making sure that they don’t grow beyond a few cases.

And health officials don’t just worry about measles. They work to control outbreaks of mumps, pertussis, hepatitis A, and all other diseases too.

Why We Worry About Measles Outbreaks

We do get concerned about measles outbreaks though.

“Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be.

To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak.”

Seth Berkley on Measles Outbreaks Are a Sign of Bigger Problems

The measles vaccine is among the most effective vaccines we have, so if we are seeing outbreaks, even though measles is very contagious, it means there is a problem.

“A focus on measles surveillance can help detect populations unreached by immunization systems and, by extension, program weaknesses. Measles serves as the ‘canary in the coal mine’ for detecting problems with immunization programs, a characteristic whose importance has recently been highlighted in the context of global health security.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review

In the late 1980s, when we had large outbreaks between 1989 to 1991, with 55,622 cases and 123 deaths, it meant that we weren’t vaccinating enough kids because Federal support for vaccine programs had dropped.

As much as anti-vaccine folks like to try and minimize how serious measles can be, it is easy to see that measles is indeed a serious, life-threatening disease. We had good nutrition, proper sanitation, and modern health care in 1990, and still, a lot of people died with measles. Rates of subacute sclerosing panencephalitis (SSPE), a late complication of measles, went up too, in the years after these outbreaks.

“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”

Panel Ties Measles Epidemic to Breakdown in Health System

Those outbreaks were fixed, as we improved access to help kids get vaccinated and protected. Unfortunately, the issue with outbreaks today isn’t about access to vaccines, at least not in the developed world. It is about parents intentionally skipping or delaying vaccines.

How do you fix that?

Hopefully with education.

Why You Should Worry About Measles Outbreaks

Did you know that after the measles outbreaks of 1989, we also saw outbreaks of rubella and congenital rubella syndrome?

  • 396 cases of rubella, 4 deaths, and 2 cases of congenital rubella syndrome in 1989
  • 1,125 cases of rubella, 8 deaths, and 32 cases of congenital rubella syndrome in 1990
  • 1,401 cases of rubella, 1 death, and 34 cases of congenital rubella syndrome in 1991

Did you know that because they have overall lower vaccination rates, measles outbreaks in Europe grow far larger, into the tens of thousands of cases, with dozens of deaths?

“We must not tolerate a world in which a child dies from a disease that can be easily prevented with a low-cost vaccine.”

Dr Tedros, WHO Director-General on World Immunization Week 2018

We worry about measles outbreaks, because we don’t want to go back to anti-vaccine folks push us back to pre-vaccine era levels of disease and deaths.

We know what happens when vaccine levels drop too low.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this NY Times article reports.

We know that vaccines are safe and necessary.

You should know that anti-vaccine propaganda that scares parents away from vaccinating and protecting their kids is rooted in myths and misinformation. They often get away with it because most parents today ahve never seen how devastating measles and other diseases can really be, so they believe stories about the Brady Bunch, instead of the advice of real experts.

You hopefully understand that’s a mistake.

More on Worrying About Measles Outbreaks

When Was the Last Measles Death in the United States?

How many measles deaths have there been in the United States in the past ten years? Dr. Bob Sears frequently says that there have been none. It is easy to see that Dr. Bob is wrong, not even counting the latest death in 2015.

Measles Deaths in the United States

Measles deaths are thought to occur in about 1 in every 500 to 1,000 reported cases. This is not just in developing countries or in people with chronic medical conditions.

Consider that in an outbreak in the United States from 1989 to 1991, amid 55,622 cases, there were 123 deaths.

More recently, measles cases and measles deaths in the United States include:

  • 2000 – 86 cases – 1 measles death (infant)  – endemic spread of measles eliminated in U.S.
  • 2001 – 116 cases – 1 measles death
  • 2002 – 44 cases
  • 2003 – 55 cases – 1 measles death (1 year old)
  • 2004 – 37 cases – record low number of measles cases
  • 2005 – 66 cases – 1 measles death (1 year old)
  • 2006 – 55 cases
  • 2007 – 43 cases
  • 2008 – 140 cases
  • 2009 – 71 cases – 2 measles deaths
  • 2010 – 63 cases – 2 measles deaths
  • 2011 – 220 cases
  • 2012 – 55 cases – 2 measles deaths
  • 2013 – 187 cases (large outbreak in New York City – 58 cases)
  • 2014 – 667 cases (the worst year for measles since 1994, including the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio)
  • 2015 – 188 cases – got off to a strong start with a big outbreak in California – 1 measles death
  • 2016 – 86 cases
  • 2017 – 118 cases

So that’s 11 measles deaths since 2000 and at least 8 measles deaths since 2005.

Why do people say that there have been no measles deaths in the United States in the past 10 years? Whether they are misinformed or intentionally trying to misinform people, they are wrong.

The Last Verifiable Measles Death in the United States

The CDC is actually contributing a bit to the confusion over measles deaths, in that when asked, they have  said that “the last verifiable death in the United States from acute measles infection occurred in 2003 when there were 2 reported deaths.”

They explain the discrepancy between that statement and other CDC reports, like the recently published “Summary of Notifiable Diseases — United States, 2012,” which clearly documents measles deaths in 2005, 2009, and 2010, by saying that those reports are based on “statistical information about deaths in the United States.”

But that statistical information comes from death certificates that are sent in from all over the United States to the National Vital Statistics System. The system isn’t like VAERS, where just anyone can send in a report. You don’t necessarily have to be a doctor to sign and file a death certificate though either, which is why the CDC is probably hung up on saying that the last verifiable measles deaths were in 2003.

To be more precise when talking about measles deaths in the United States, since it doesn’t seem like the CDC has verified each and every measles death after 2003, it is likely best to say that death certificates have been filed in 2005, 2009 (2), 2010 (2), and 2012 (2) that listed measles as a cause of death code.

Of course, that still means that there have been measles deaths in the United States since 2003.

SSPE – More Measles Deaths

Lately, in addition to deaths from acute measles infections, there have been even more deaths from subacute sclerosing panencephalitis (SSPE).

About 6 to 8 years after having measles, children with SSPE develop progressive neurological symptoms, including memory loss, behavior changes, uncontrollable movements, and even seizures. As symptoms progress, they may become blind, develop stiff muscles, become unable to walk, and eventually deteriorate to a persistent vegetative state.

Children with SSPE usually die within 1 to 3 years of first developing symptoms, including in the United States:

  • 2000 – 5 SSPE deaths
  • 2001 – 2 SSPE deaths
  • 2002 – 5 SSPE deaths
  • 2003 – 0
  • 2004 – 1 SSPE death
  • 2005 – 2 SSPE deaths
  • 2006 – 3 SSPE deaths
  • 2007 – 3 SSPE deaths
  • 2008 – 3 SSPE deaths
  • 2009 – 2 SSPE deaths
  • 2010 – 0
  • 2011 – 4 SSPE deaths
  • 2012 – 1 SSPE death
  • 2013 – 1 SSPE death
  • 2014 – 0
  • 2015 – 0
  • 2016 – 0
  • 2017 – 0

That’s 32 SSPE deaths since 2000 and at least 19 SSPE deaths since 2005. Why so many? Many of them can likely be attributed to the large number of cases associated with measles outbreaks from 1989 to 1991.

Fortunately, as the number of measles cases has been dropping in the post-vaccine era, so have the number of SSPE deaths.

The National Registry for SSPE, reported that there were at least 453 cases between 1960 and 1976. There were 225 deaths from SSPE between 1979 and 1998. The registry wasn’t established until 1969 though, and it is now becoming clear that the risk of developing SSPE is much higher than once thought.

A recent study of measles in Germany has found that the risk of developing SSPE is about 1 in 1,700 to 1 in 3,300 cases of measles.

Other Myths About Measles Deaths

One of the classic measles myths we hear is that measles was disappearing even before the measles vaccine was developed. It is true that measles deaths had been dropping since the turn of the century.

The measles death rate (deaths per 100,000 people) in the United States was:

  • 1900 – 13.3 (about 7000 deaths)
  • 1910 – 12.4
  • 1920 – 8.8
  • 1930 – 3.2
  • 1935 – 3.1
  • 1940 – 0.5
  • 1945 – 0.2
  • 1950 – 0.3 (468 deaths)
  • 1955 – 0.2 (345 deaths)
  • 1960 – 0.2 (380 deaths)
  • 1963 – first measles vaccine licensed
  • 1965 – 0.1 (276 deaths)
  • 1970 – 0.0 (89 deaths)
  • 1975 – 0.0 (20 deaths)
  • 1980 – 0.0 (11 deaths)
  • 1985 – 0.0 (4 deaths)

That’s not surprising though. The general death rate had dropped from 17.8 in 1900 to 7.6 in 1960. For infants under age 12 months, the death rate dropped from 162.4 in 1933 to 27 in 1960.

This simply reflects that vaccines were not the only medical technology that helped to save lives in the 20th century and not that measles was already disappearing. Penicillin, insulin, vitamin D, blood typing (allows transfusions of blood that has been typed and cross-matched), dialysis machines, and mechanical ventilators were all discovered in the early 1900s.

anti-vax-measles-graph
Despite how anti-vaccine charts try and mislead you, measles was still very deadly when the first measles vaccines were introduced.

If you notice though, the death rate for measles got stuck after the 1940s at about 0.2 to 0.3, even as modern medicine continued to advance. That’s about 300 to 500 measles deaths each year in the United States. This was after World War II and through the 1950s and early 1960s, hardly a time of poor hygiene or poor nutrition or when Americans were without access to medical care.

It took about 20 years for those deaths to start dropping again, and it took the coming of the measles vaccine to do it.

So if we stop vaccinating, we won’t get to 7,000 measles deaths a year again in the United States. Modern medicine has improved a great deal since 1900. We would eventually get to about 320 to 960 measles deaths a year though (using our current population of 320 million people and a measles death rate between 0.1 and 0.3).

Other Facts About Measles Deaths

People still die of measles.

What else do you need to know about measles deaths?

  • SSPE is caused by wild type measles. Vaccine strain measles has never been found in the brain tissue of anyone who has ever died of SSPE.
  • Although SSPE was first described by Dr. James R. Dawson, JR as a new type of epidemic encephalitis in 1933 (Dawson’s disease), that it is a late complication of a natural measles infection wasn’t discovered until much later.
  • People have recently died of measles in other industrial countries too. Basically anywhere there have been measles outbreaks, there have been measles deaths, including Canada, Japan, Germany, the Netherlands, the UK, and France, etc.
  • Worldwide, about 400 people die each and every day from measles.

The latest measles deaths we have been hearing about?

Dozens of infants, children, and adults, almost all unvaccinated have died in large outbreaks since the beginning of 2016 in Europe.

What To Know about Measles Deaths

Measles is still deadly, even in this era of modern medicine, sanitation and good nutrition.

More on Measles Deaths

The Myth That Measles Isn’t Deadly

Have you ever heard that measles isn’t deadly?

Sure, there are the folks who think that all vaccine preventable diseases are so mild that they wouldn’t kill you unless you lived in a Third World country.

The Myth That Measles Isn’t Deadly

But there are also folks, usually the same folks, who think that the measles virus doesn’t actually kill you – it is instead the complications that are deadly.

For most people, that’s a distinction without a difference.

“The acute pathological effects of measles include the destruction of respiratory epithelium and depression of cellular immunity. These effects interact to transiently increase measles-infected hosts’ susceptibility to respiratory bacterial strains to which they are not immune.”

Measles epidemics of variable lethality in the early 20th century.

After all, if you have measles and die, you probably don’t care if you died because of:

  • viral pneumonia
  • a secondary bacterial pneumonia
  • acute respiratory distress syndrome (ARDS)
  • acute measles encephalitis (swelling of the brain)
  • Subacute sclerosing panencephalitis (SSPE) – a late complication of natural measles infections

In the pre-vaccine era, before the early 1960s, about 400 to 500 people would die each year from measles and these complications.

So much for the myth that measles isn’t deadly.

But didn’t they all have underlying medical problems – another measles myth?

No they didn’t. One study of measles deaths in the 1960s found that only about 17% of the people who died with measles as the cause of death had an underlying disease.

And we now know that having a natural measles infection lowers your immunity and puts you at risk of dying from something else, even after you have recovered from your measles infection. That’s why mortality rates go down so much more than expected after measles vaccine programs are introduced in an area.

Measles Is Still Not Marvelous

Although the first measles vaccine was licensed in 1963, an improved version wasn't available until 1968.
Although the first measles vaccine was licensed in 1963, an improved version wasn’t available until 1968.

While it is true that people rarely die of measles in the United States and other developed countries anymore, that’s just because most people are vaccinated and really big outbreaks aren’t that common, especially since the endemic spread of measles was eliminated in 2000.

You don’t have to go back to the pre-vaccine era to remember how measles kills though.

Measles is still deadly, even in this era of modern medicine, good nutrition, and clean water. Not that people in the United States didn’t eat well and have access to indoor plumbing in the 1950s, but medical care has improved.

People can still die when they get measles though.

Consider that at least 123 people died in the United States during the large measles epidemics from 1989 to 1991. Another 11,000 were hospitalized, among only about 55,000 cases.

During even more recent outbreaks of measles:

  • a pregnant woman with measles was hospitalized and had a miscarriage (2013 measles outbreak in Brooklyn)
  • an immunocompromised woman died of pneumonia due to measles (2015 measles outbreak in Clallam County, Washington)

There have been other measles deaths and complications of these preventable infections.

Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.

Although before the Clallam County death, the CDC would say that “the last verifiable death in the United States from acute measles infection occurred in 2003 when there were 2 reported deaths,” death certificates had been filed in 2005, 2009 (2), 2010 (2), and 2012 (2) which listed measles as a cause of death code. These measles deaths are listed in the CDC “Summary of Notifiable Diseases — United States, 2012,” and in the CDC Wonder Compressed Mortality Files Underlying Cause-of-Death database.

Again, that there aren’t more simply reflects that most people are vaccinated.

But when we start seeing more and more cases of measles, more and more people will start to die. Just look at the outbreaks in Europe right now…

We also shouldn’t forget that worldwide, even after a 79% drop in measles deaths just since 2000, there were still 134,200 measles deaths in 2015, about 367 deaths a day.

What To Know About The Myth That Measles Isn’t Deadly

Not only are measles infections deadly, usually from pneumonia and encephalitis, but a natural measles infection can also cause years of immunosuppression, increasing your risk of death from other diseases too.

More About The Myth That Measles Isn’t Deadly